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TITLE OF BILL: An act to amend the social services law, in relation to the special advisory review panel on Medicaid managed care

PURPOSE OR GENERAL IDEA OF BILL: To update the composition and the charge of the Medicaid Managed Care Advisory Review Panel (MMCARP).

SUMMARY OF SPECIFIC PROVISIONS: The bill amends section 364-jj of the Social Services Law to add Child Health Plus, Family Health Plus, Managed Long Term Care and other public managed-health care plans to the charge of the MMCARP and add two public members with expertise in disabilities and pediatrics. The bill would also have MMCARP review issues of the appropriateness and timeliness of services, the integration of federal health care reform, trends in service denials and demographic data, review of the federal waiver, as well as public information for choosing among managed long term care plans.

JUSTIFICATION: Since the statute's enactment. in 1996, the MMCARP has performed an important function collaboratively working with numerous state officials in monitoring mandatory Medicaid managed care.

Provisions in the 2011-2012 budget will result in the expansion of mandatory Medicaid managed care to vulnerable populations who were previously covered by fee-for-service, including physically and developmentally disabled individuals, children in foster care, and homeless families. There will also be a significant increase in home care beneficiaries enrolled by mandate into managed long term care plans, forcing individuals with complex needs to manage their care in a new delivery system. It is increasingly important that the MMCARP provide an opportunity for monitoring of these programs by a diverse group of stakeholders including consumer advocates, consumers, health plans and providers of services.

This bill will charge MMCARP with monitoring the phase-in schedule for the enrollment of new populations in Medicaid managed care as well as the availability of essential services for these populations. In addition, this bill will increase the public's role in providing feedback on the significant changes soon to be implemented in the Medicaid delivery system. Active monitoring by stakeholders is increasingly important as both amendments to state law and federal health reform lead to increased enrollment in managed care and the implementation of new service delivery models for an increasingly diverse beneficiary population.

PRIOR LEGISLATIVE HISTORY: 2011-2012: A.7651-A passed Assembly

FISCAL IMPLICATIONS: None to the state

EFFECTIVE DATE: Immediately

Text

STATE OF NEW YORK
________________________________________________________________________
5896--A
2013-2014 Regular Sessions
IN SENATE
June 19, 2013
___________

Introduced by Sen. RIVERA -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules -- recommitted to
the Committee on Health in accordance with Senate Rule 6, sec. 8 --
committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee
AN ACT to amend the social services law, in relation to the special
advisory review panel on Medicaid managed care
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 364-jj of the social services law, as amended by
section 80-a of part A of chapter 56 of the laws of 2013, is amended to
read as follows:
S 364-jj. Special advisory review panel on Medicaid managed care. (a)
There is hereby established a special advisory review panel on Medicaid
managed care AND RELATED PUBLIC HEALTH INSURANCE PROGRAMS, INCLUDING
CHILD HEALTH PLUS, FAMILY HEALTH PLUS, MANAGED LONG TERM CARE PROGRAMS
AND RELATED CARE COORDINATION MODELS, MANAGED CARE PROGRAMS DIRECTED AT
COORDINATING CARE FOR DUALLY ELIGIBLE MEDICAID AND MEDICARE ENROLLEES,
AND OTHER PUBLIC HEALTH COVERAGE CARE MANAGEMENT PROGRAMS, INCLUDING BUT
NOT LIMITED TO HEALTH HOMES AND MEDICAL HOMES. The panel shall consist
of [twelve] THIRTEEN members who shall be appointed as follows: [four]
FIVE by the governor, one of which shall serve as the chair, TWO OF
WHICH SHALL BRING EXPERTISE IN ACCESS ISSUES FACING MEDICAID CONSUMERS
WITH DISABILITIES, AND ONE OF WHICH SHALL BEING EXPERTISE IN ACCESS
ISSUES FACING CHILDREN, AND ONE SHALL BE A MEDICAID BENEFICIARY; three
each by the temporary president of the senate and the speaker of the
assembly; and one each by the minority leader of the senate and the
minority leader of the assembly. At least three members of such panel
shall be members of the joint advisory panel established under section
13.40 of the mental hygiene law. Members shall serve without compen-
sation but shall be reimbursed for appropriate expenses. The department

EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01605-06-4

S. 5896--A 2

shall provide technical assistance and access to data as is required for
the panel to effectuate the mission and purposes established herein. THE
PANEL SHALL BE REQUIRED TO SEEK PUBLIC COMMENT ON MATTERS WITHIN ITS
JURISDICTION. PANEL MEETING TIMES, AGENDAS, AND MINUTES SHALL BE POSTED
PUBLICLY ON THE DEPARTMENT'S WEBSITE AT LEAST ONE WEEK PRIOR TO EACH
MEETING.
(b) The panel shall MEET NO LESS THAN SIX TIMES PER YEAR, WITH ADDI-
TIONAL SUBCOMMITTEE MEETINGS AS DEEMED NECESSARY TO ADDRESS SPECIALIZED
ISSUES, IN ORDER TO:
(i) determine whether there is sufficient managed care provider
participation in the Medicaid managed care program AND RELATED PROGRAMS;
(ii) determine whether managed care providers meet proper enrollment
targets that permit as many Medicaid recipients as possible to make
their own health plan decisions, thus minimizing the number of automatic
assignments;
(iii) review AND DETERMINE THE APPROPRIATENESS OF the phase-in sched-
ule, AND THE AVAILABILITY OF SPECIALTY SERVICES for enrollment[,] of
ADDITIONAL POPULATIONS AND managed care providers under both the volun-
tary and mandatory programs AND EVALUATE STEPS TAKEN TO ENSURE CONTINUI-
TY OF CARE DURING AND AFTER THE TRANSITION;
(iv) assess the impact of managed care provider marketing and enroll-
ment strategies, [and the] INCLUDING public education [campaign
conducted in New York city, on enrollees] CAMPAIGNS, ENROLLEE partic-
ipation in Medicaid managed care plans AND RELATED PROGRAMS;
(v) evaluate the adequacy of managed care provider capacity by review-
ing established capacity measurements and monitoring actual access to
plan practitioners, INCLUDING TIMELY ACCESS TO SPECIALTY CARE FOR PEOPLE
WITH DISABILITIES AND OTHERS IN NEED OF SUCH CARE, WITH PARTICULAR
ATTENTION TO CAPACITY FOR SERVICES PREVIOUSLY PROVIDED IN THE TRADI-
TIONAL FEE FOR SERVICE ENVIRONMENT;
(vi) examine the [cost] implications of [populations excluded and
exempted from Medicaid managed care] FEDERAL HEALTH CARE REFORM ON THE
MEDICAID MANAGED CARE PROGRAM AND RELATED PROGRAMS, WITH PARTICULAR
ATTENTION TO THE INTEGRATION OF PUBLIC PROGRAM FUNCTIONS WITH SUBSIDIZED
PRODUCTS AVAILABLE IN ANY POTENTIAL STATE INSURANCE EXCHANGE AND ANY
OTHER SUBSIDIZED PRODUCTS, SUCH AS A BASIC HEALTH PLAN;
(vii) in accordance with the recommendations of the joint advisory
council established pursuant to section 13.40 of the mental hygiene law,
advise the commissioners of health and developmental disabilities with
respect to the oversight of DISCOs and of health maintenance organiza-
tions and managed long term care plans providing services authorized,
funded, approved or certified by the office for people with develop-
mental disabilities, and review all managed care options provided to
persons with developmental disabilities, including: the adequacy of
support for habilitation services; the record of compliance with
requirements for person-centered planning, person-centered services and
community integration; the adequacy of rates paid to providers in
accordance with the provisions of paragraph [1] (L) of subdivision four
of section forty-four hundred [three] THREE-G of the public health law,
paragraph (a-2) of subdivision eight of section forty-four hundred three
of the public health law or paragraph (a-2) of subdivision twelve of
section forty-four hundred three-f of the public health law; and the
quality of life, health, safety and community integration of persons
with developmental disabilities enrolled in managed care; [and]

S. 5896--A 3

(viii) EVALUATE TRENDS IN SERVICE DENIALS BY MEDICAID MANAGED CARE
PLANS AND RELATED PROGRAMS, ASSESS EFFECTIVENESS OF GRIEVANCE AND APPEAL
MECHANISMS FOR CONSUMERS;
(IX) EVALUATE DATA COLLECTION AND REPORTING ON HEALTH CARE ACCESS AND
QUALITY BY RACE, ETHNICITY, LANGUAGE, DISABILITY AND OTHER FACTORS AND
THE AVAILABILITY OF SERVICES AND PROGRAMS THAT ADDRESS THE DISPARITIES
IN ACCESS TO CARE AND OUTCOMES OF CARE;
(X) EVALUATE IMPLEMENTATION OF CONSUMER PROTECTIONS;
(XI) REVIEW WAIVER APPLICATIONS BEFORE ANY DRAFT PROPOSALS ARE SUBMIT-
TED TO THE FEDERAL GOVERNMENT AND AMENDMENTS AND STATE PLAN AMENDMENTS
RELATED TO TOPICS AND PROGRAMS WITHIN ITS JURISDICTION, AND SOLICIT
PUBLIC INVOLVEMENT IN THE PROPOSALS;
(XII) REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF PROGRAM
MATERIALS AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO, NETWORK,
CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
(XIII) examine other issues as it deems appropriate.
(c) Commencing January first, [nineteen hundred ninety-seven] TWO
THOUSAND FIFTEEN and quarterly thereafter the panel shall [submit a
report regarding the status of Medicaid managed care in the state and
provide recommendations if it] PROVIDE WRITTEN RECOMMENDATIONS AND INPUT
AS IT deems appropriate to the governor, the temporary president and the
minority leader of the senate, and the speaker and the minority leader
of the assembly ON MATTERS WITHIN ITS JURISDICTION.
S 2. Section 364-jj of the social services law, as added by chapter
649 of the laws of 1996, is amended to read as follows:
S 364-jj. Special advisory review panel on Medicaid managed care. (a)
There is hereby established a special advisory review panel on Medicaid
managed care AND RELATED PUBLIC HEALTH INSURANCE PROGRAMS, INCLUDING
CHILD HEALTH PLUS, FAMILY HEALTH PLUS, MANAGED LONG TERM CARE PROGRAMS
AND RELATED CARE COORDINATION MODELS, MANAGED CARE PROGRAMS DIRECTED AT
COORDINATING CARE FOR DUALLY ELIGIBLE MEDICAID AND MEDICARE ENROLLEES,
AND OTHER PUBLIC HEALTH COVERAGE CARE MANAGEMENT PROGRAMS, INCLUDING BUT
NOT LIMITED TO HEALTH HOMES AND MEDICAL HOMES. The panel shall consist
of [nine] ELEVEN members who shall be appointed as follows: [three] FIVE
by the governor, one of which shall serve as the chair, TWO OF WHICH
SHALL BRING EXPERTISE IN ACCESS ISSUES FACING MEDICAID CONSUMERS WITH
DISABILITIES, AND ONE OF WHICH SHALL BRING EXPERTISE IN ACCESS ISSUES
FACING CHILDREN, AND ONE SHALL BE A MEDICAID BENEFICIARY; two each by
the temporary president of the senate and the speaker of the assembly;
and one each by the minority leader of the senate and the minority lead-
er of the assembly. [All members shall be appointed no later than
September first, nineteen hundred ninety-six.] Members shall serve with-
out compensation but shall be reimbursed for appropriate expenses. The
department shall provide technical assistance and access to data as is
required for the panel to effectuate the mission and purposes estab-
lished herein. THE PANEL SHALL BE REQUIRED TO SEEK PUBLIC COMMENT ON
MATTERS WITHIN ITS JURISDICTION. PANEL MEETING TIMES, AGENDAS, AND
MINUTES SHALL BE POSTED PUBLICLY ON THE DEPARTMENT'S WEBSITE AT LEAST
ONE WEEK PRIOR TO EACH MEETING.
(b) The panel shall MEET NO LESS THAN SIX TIMES PER YEAR, WITH ADDI-
TIONAL SUBCOMMITTEE MEETINGS AS DEEMED NECESSARY TO ADDRESS SPECIALIZED
ISSUES, IN ORDER TO:
(i) determine whether there is sufficient managed care provider
participation in the Medicaid managed care program AND RELATED PROGRAMS;
(ii) determine whether managed care providers meet proper enrollment
targets that permit as many Medicaid recipients as possible to make

S. 5896--A 4

their own health plan decisions, thus minimizing the number of automatic
assignments;
(iii) review AND DETERMINE THE APPROPRIATENESS OF the phase-in sched-
ule, AND THE AVAILABILITY OF SPECIALTY SERVICES for enrollment[,] of
ADDITIONAL POPULATIONS AND managed care providers under both the volun-
tary and mandatory programs AND EVALUATE STEPS TAKEN TO ENSURE CONTINUI-
TY OF CARE DURING AND AFTER THE TRANSITION;
(iv) assess the impact of managed care provider marketing and enroll-
ment strategies, [and the] INCLUDING public education [campaign
conducted in New York city, on enrollees] CAMPAIGNS, ENROLLEE partic-
ipation in Medicaid managed care plans AND RELATED PROGRAMS;
(v) evaluate the adequacy of managed care provider capacity by review-
ing established capacity measurements and monitoring actual access to
plan practitioners, INCLUDING TIMELY ACCESS TO SPECIALTY CARE FOR PEOPLE
WITH DISABILITIES AND OTHERS IN NEED OF SUCH CARE, WITH PARTICULAR
ATTENTION TO CAPACITY FOR SERVICES PREVIOUSLY PROVIDED IN THE TRADI-
TIONAL FEE FOR SERVICE ENVIRONMENT;
(vi) examine the [cost] implications of [populations excluded and
exempted from Medicaid managed care; and] FEDERAL HEALTH CARE REFORM ON
THE MEDICAID MANAGED CARE PROGRAM AND RELATED PROGRAMS, WITH PARTICULAR
ATTENTION TO THE INTEGRATION OF PUBLIC PROGRAM FUNCTIONS WITH SUBSIDIZED
PRODUCTS AVAILABLE IN ANY POTENTIAL STATE INSURANCE EXCHANGE AND ANY
OTHER SUBSIDIZED PRODUCTS, SUCH AS A BASIC HEALTH PLAN;
(vii) EVALUATE TRENDS IN SERVICE DENIALS BY MEDICAID MANAGED CARE
PLANS AND RELATED PROGRAMS, ASSESS EFFECTIVENESS OF GRIEVANCE AND APPEAL
MECHANISMS FOR CONSUMERS;
(VIII) EVALUATE DATA COLLECTION AND REPORTING ON HEALTH CARE ACCESS
AND QUALITY BY RACE, ETHNICITY, LANGUAGE, DISABILITY AND OTHER FACTORS
AND THE AVAILABILITY OF SERVICES AND PROGRAMS THAT ADDRESS THE DISPARI-
TIES IN ACCESS TO CARE AND OUTCOMES OF CARE;
(IX) EVALUATE IMPLEMENTATION OF CONSUMER PROTECTIONS;
(X) REVIEW WAIVER APPLICATIONS BEFORE ANY DRAFT PROPOSALS ARE SUBMIT-
TED TO THE FEDERAL GOVERNMENT AND AMENDMENTS AND STATE PLAN AMENDMENTS
RELATED TO TOPICS AND PROGRAMS WITHIN ITS JURISDICTION, AND SOLICIT
PUBLIC INVOLVEMENT IN THE PROPOSALS;
(XI) REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF PROGRAM
MATERIALS AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO, NETWORK,
CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
(XII) examine other issues as it deems appropriate.
(c) Commencing January first, [nineteen hundred ninety-seven] TWO
THOUSAND FIFTEEN and quarterly thereafter the panel shall [submit a
report regarding the status of Medicaid managed care in the state and
provide recommendations if it] PROVIDE WRITTEN RECOMMENDATIONS AND INPUT
AS IT deems appropriate to the governor, the temporary president and the
minority leader of the senate, and the speaker and the minority leader
of the assembly ON MATTERS WITHIN ITS JURISDICTION.
S 3. This act shall take effect immediately; provided that the amend-
ments to section 364-jj of the social services law made by section one
of this act shall be subject to the expiration and reversion of such
section pursuant to section 84 of part A of chapter 56 of the laws of
2013, as amended, when upon such date the provisions of section two of
this act shall take effect.

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